等比重罗哌卡因蛛网膜下腔麻醉在剖宫产手术中的应用研究

A clinical study of subarachnoid block anesthesia with isobaric ropivacaine in cesarean section

目的:在剖宫产手术中应用0.75%、0.5%、0.25%的等比重罗哌卡因蛛网膜下腔麻醉,比较各浓度临床应用的优缺点。方法:选择ASAⅠ～Ⅲ级、宜实施剖宫产手术患者600例,随机分为Ⅰ、Ⅱ、Ⅲ组,每组200例。用针内针法腰-硬联合麻醉技术在L2-3实施联合麻醉,腰麻分别用0.75%、0.5%、0.25%等比重罗哌卡因2ml。比较三组患者术中血压、心率变化及升压药使用情况,最高脊位阻滞平面、最高节段出现时间、阻滞起效时间、麻醉维持时间、运动阻滞情况及硬膜外追加药物情况,以及肌松满意度、患者麻醉中主观感觉舒适度等。结果:Ⅰ组平均最高阻滞平面在T5水平,血压下降,心率增加明显,最高节段出现时间、Ⅱ阻滞起效时间较短,麻醉维持时间长,患者肌松良好,部分病人出现恶心、呕吐、舒适度较组差;组最高阻滞平面在T7水平,血压、心率变化不大,最高节段出现时间、阻滞起效时间、麻醉维持时间,介于Ⅰ、Ⅱ组之间,患者肌松良好、舒适度较好。Ⅲ组最高阻滞平面在T9水平,血压、心率变化不大,最高节段出现时间、阻滞起效时间较长,麻醉维持时间短,肌松较差,舒适度较组差Ⅱ。以上各指标比较三组差异有统计学意义。结论:0.5%等比重罗哌卡因蛛网膜下腔麻醉更适合剖宫产手术的需求。

Objective：Using isobaric subarachnoid anesthesia with 3 concentrations of 0.75%,0.5%,0.25% ropivacaine,to compare the advantages and disadvantages of the three kinds of ropivacaine in cesarean section.Methods：600 patients ASAI-II which scheduled for cesarean section were randomly divided into three groups （Ⅰ,Ⅱ,Ⅲ）,200 cases in each group.Combined subarachnoid epidural anesthesia （CSEA） with needle in needle method was injected at at L2-3interspace.2 ml of 0.75%,0.5% and 0.25%isobaric ropivacaine was given respectively.The following observations and comparisons were made by：the patient’s blood pressure,heart rate and boost drug used;the highest ridges-bit block level,the maximum segments occurrence time,block onset time,anesthesia duration,motor block and epidural additional drug;satisfaction of muscle relaxation and patient’s comfort degree.Results：In Group Ⅰ,the average maximum block plane was at the T5 level;blood pressure decreased and heart rate increased significantly,The maximum level of anesthesia gained and block onset time occurred the soonest,anesthesia maintained for a longer time in patients with good muscle relaxation,and some patients experienced nausea and vomiting.They felt less comfortable than patients in Group Ⅱ.In Group Ⅱ,the highest block plane was at the T7 level,blood pressure and heart rate changed but only a little,the parameters concerning maximum level of anesthesia,block onset time and anesthesia duration lay between those in Group Ⅰ and Group Ⅲ.The patients had good muscle relaxation and felt comfortable.In Group Ⅲ,the average maximum block plane was at the T9 level,blood pressure and heart rate changed little,the maximum level of anesthesia,block onset time was the shortest,anesthesia maintained for the shortest time in patients with poor muscle relaxation,as they felt less comfortable than those in Group Ⅱ.Compared to three groups,there was significant difference.Conclusions：Subarachnoid block anesthesia with 0.5% isobaric ropivacaine tend to bring about satisfactory anaesthesia and might meet the needs of Cesarean section ideally.